Provider Demographics
NPI:1306977475
Name:KOVACS, DEBRA (DOM, LICAC, RN)
Entity type:Individual
Prefix:DR
First Name:DEBRA
Middle Name:
Last Name:KOVACS
Suffix:
Gender:F
Credentials:DOM, LICAC, RN
Other - Prefix:DR
Other - First Name:DEBRA
Other - Middle Name:
Other - Last Name:DIERS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DOM, LICAC, RN
Mailing Address - Street 1:91 WOODHAVEN RD
Mailing Address - Street 2:
Mailing Address - City:GLASTONBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06033-1855
Mailing Address - Country:US
Mailing Address - Phone:860-633-5395
Mailing Address - Fax:
Practice Address - Street 1:91 WOODHAVEN RD
Practice Address - Street 2:
Practice Address - City:GLASTONBURY
Practice Address - State:CT
Practice Address - Zip Code:06033-1855
Practice Address - Country:US
Practice Address - Phone:860-633-5395
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT000013171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist